Organization Name: | CONSOLATION, INC. |
NPI Number: | 1154686343 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUBY DENISE GRAVETT (PRESIDENT) |
Mailing Address: | 327 S 500 E American Fork |
State: | UT US |
Postal Code: | 840032525 |
Phone Number: | 8016694414 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2012 |
NPI Last Update Date: | 08/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 63213036004 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |